Effectiveness of influenza vaccination programme in preventing hospital admissions, Valencia, 2014/15 early results.

Preliminary results for the 2014/15 season indicate low to null effect of vaccination against influenza A(H3N2)-related disease. As of week 5 2015, there have been 1,136 hospital admissions, 210 were due to influenza and 98% of subtype A strains were H3. Adjusted influenza vaccine effectiveness was 33% (range: 6-53%) overall and 40% (range: 13% to 59%) in those 65 years and older. Vaccination reduced by 44% (28-68%) the probability of admission with influenza.

Validez de la historia clínica y sistemas de información en los estudios de actividad asistencial en atención primaria / Validity of clinical records and information systems in the studies of health-care delivery in primary care

Objetivo. Validar el grado de registro del proceso clínico asistencial en la historia clínica (HC) y la actividad asistencial en la hoja de actividad (HA). Construir una guía de recomendaciones sobre la validez de estos documentos para el registro de la actividad. Tipo estudio. Observacional, transversal, multicéntrico. Emplazamiento. Cuatro consultas médicas de 12 centros de salud de la Comunidad Valenciana. Participantes. Un total de 2.051 visitas, 284 historias y 407 hojas de actividad. Mediciones y resultados principales. Se validó la información registrada por los médicos en la HC y HA, por observadores externos que recogen directamente en consulta toda la actividad asistencial de la jornada. Se analiza: a) en la HC, cumplimentación del SOAP; b) en la HA, media por profesional y día de pacientes citados, sin cita, domicilios y duración de las consultas; c) información de los documentos validados con respecto a la organización de las consultas; d) análisis de la actividad asistencial según su previsibilidad y contenido clínico, y e) guías de práctica clínica con indicadores de validez, utilidad clínica e índice de fiabilidad (kappa). Conclusiones. Los documentos validados no reflejan adecuadamente la realidad de la demanda sanitaria. Se detecta un sesgo de infrarregistro y problemas de validez que pueden limitar su utilización como fuente de información para la planificación y gestión sanitaria

Objectives. To examine how well the clinical process was recorded in the clinical history (CH), and care delivery on the activity sheet (AS). To assemble a series of recommendations on the validity of these documents for recording health care delivery. Design. Multi-centred, observational, and cross-sectonal study. Setting. Four medical clinics at 12 health centres in the Community of Valencia, Spain. Participants. There were 2051 attendances, with 284 CH and 407 AS involved. Main measurements and results. The information recorded by doctors in the CH and on the AS was validated by external observers who collected directly at the consultation the working day's entire care activity. The following was analysed: 1) in the CH, filling out of the "SOAP" form (basic info.); 2) on the AS, mean per professional per day of scheduled and on-demand patients, home visits and length of consultations; 3) information in the documents validated on the organisation of consultations; 4) analysis of care delivery according to how predictable it is and its clinical content; 5) clinical practice guidelines with validity and clinical usefulness indicators and reliability index (kappa). Conclusions. The documents validated do not properly reflect the reality of health care demand. There was an under-recording bias and validity problems that may limit their usefulness as sources of information for health care planning and management

[Characteristics of health care demand in family medicine clinics in a health area of the community of Valencia]. / Características de la demanda sanitaria en las consultas de medicina de familia de un área de salud de la Comunidad Valenciana.

OBJECTIVE: To measure with primary data the kinds of family doctor consultations, the reasons for them and the interruptions. DESIGN: Observational, transversal, and multi-centred study. SETTING: All the health centres in Area 17 of the Community of Valencia. PARTICIPANTS: Representative sample of 2051 patients belonging to 20 family medicine lists at the 13 health centres in the Area, selected by sampling stratified for health centres and randomised by medical key. MAIN MEASUREMENTS: All the activity occurring during the working day was monitored by an outside observer in the consulting room, who recorded the types of consultation (prior appointment, on-demand, scheduled, urgent, at home, by phone or through a family member) and the reasons for them (as a function of their clinical content for acute pathology, chronic pathology or preventive activities, bureaucratic-administrative reasons or to collect test results). The interruptions to the consultation were recorded. The means, percentages and 95% confidence limits were calculated. RESULTS: Women occasioned 57.5% (95% CI, 55.4-59.6) of demand; and the elderly, 35.9% (33.6%-38.2%). Mean attendance time was 5.38 +/- 4.45 minutes. 23.6% (25.4%-21.8%) attended without prior appointment; in 14.7% (16.2%-13.2%) a family member attended; 6.6% (7.7%-5.5%) were urgent; and 0.7% (1.1%-0.3%) were telephone consultations. 65.3% (67.4%-63.2%) of consultations were bureaucratic, and preventive measures were taken only in 3.4% (4.2%-2.6%). 21.8% (23.6%-20%) of patients consulted for clinical + bureaucratic reasons; and 35.5% (37.6%-33.4%), solely for bureaucratic reasons. In 12% (13.4%-10.6%) there were interruptions, mainly for phone calls (3.9%). CONCLUSION: The over-65s caused over a third of all consultations. There was a high attendance without a prior appointment. There were few preventive activities. In consultations, bureaucratic activity takes up more time than clinical activity (care and prevention).

Características de la demanda sanitaria en las consultas de medicina de familia de un área de salud de la Comunidad Valenciana / Characteristics of health care demand in family medicine clinics in a health area of the Community of Valencia

Objetivo. Cuantificar con datos primarios los tipos, motivos e interrupciones en las consultas de medicina de familia. Diseño. Estudio observacional, transversal y multicéntrico. Emplazamiento. Todos los centros de salud del Área 17 de la Comunidad Valenciana. Participantes. Muestra representativa de 2.051pacientes pertenecientes a 20 consultas de medicina familiar en los 13 centros de salud del área, seleccionados por muestreo estratificado por centros de salud y aleatorio por clave médica. Mediciones principales. Se recogió mediante un observador externo en la consulta toda la actividad generada durante la jornada laboral, registrando los tipos de consulta (cita previa, demanda, programada, urgente, domicilio, telefónica o por familiar) y los motivos (en función de su contenido clínico para una enfermedad aguda o crónica, actividades preventivas, burocrático administrativo, o recoger resultados de pruebas). Se registraron las interrupciones en la consulta. Se calcularon las medias y los porcentajes, así como intervalos de confianza (IC) del 95%.Resultados. Las mujeres ocasionan el 57,5%(IC del 95%, 55,4-59,6) de la demanda y los ancianos generan el 35,9% (IC del 95%,33,6-38,2%). El tiempo medio asistencial fue de 5,38 ± 4,45 min. El 23,6% (25,4-21,8%)acude sin cita previa, el 14,7% (16,2-13,2%)acude en lugar de un familiar, el 6,6% (7,7-5,5%) solicita una visita urgente y el 0,7%(1,1-0,3%) mantiene una visita telefónica. Un65,3% (67,4-63,2%) de las consultas son burocráticas y sólo en el 3,4% (4,2-2,6%) se realizan actividades preventivas. El 21,8%(23,6-20%) de los pacientes consultan por algún aspecto clínico y burocrático y el 35,5%(37,6-33,4%) sólo por un tema burocrático. En el 12% (13,4-10,6%) se produjeron interrupciones, fundamentalmente por llamadas telefónicas (3,9%).Conclusión. La población mayor de 65 años genera más de un tercio de las consultas. Se detecta un elevado porcentaje de visitas sin cita previa. Se realizan pocas actividades preventivas. La actividad burocrática de las consultas es mayor que la actividad clínica(asistencial y preventiva)

Objective. To measure with primary data the kinds of family doctor consultations, the reasons for them and the interruptions. Design. Observational, transversal, and multicentred study. Setting. All the health centres in Area 17 of the Community of Valencia. Participants. Representative sample of 2051patients belonging to 20 family medicine listsat the 13 health centres in the Area, selected by sampling stratified for health centres andrandomised by medical key. Main measurements. All the activity occurring during the working day was monitored by an outside observer in the consulting room, who recorded the types of consultation (prior appointment, on-demand, scheduled, urgent, at home, by phone or through a family member)and the reasons for them (as a function of their clinical content for acute pathology, chronic pathology or preventive activities, bureaucratic administrative reasons or to collect test results).The interruptions to the consultation were recorded. The means, percentages and 95%confidence limits were calculated. Results. Women occasioned 57.5% (95% CI,55.4-59.6) of demand; and the elderly, 35.9%(33.6%-38.2%). Mean attendance time was5.38±4.45 minutes. 23.6% (25.4%-21.8%)attended without prior appointment; in 14.7%(16.2%-13.2%) a family member attended;6.6% (7.7%-5.5%) were urgent; and 0.7%(1.1%-0.3%) were telephone consultations.65.3% (67.4%-63.2%) of consultations were bureaucratic, and preventive measures were taken only in 3.4% (4.2%-2.6%). 21.8%(23.6%-20%) of patients consulted for clinical+ bureaucratic reasons; and 35.5% (37.6%-33.4%), solely for bureaucratic reasons. In 12%(13.4%-10.6%) there were interruptions, mainly for phone calls (3.9%).Conclusion. The over-65s caused over a third of all consultations. There was a high attendance without a prior appointment. There were few preventive activities. In consultations, bureaucratic activity takes up more time than clinical activity (care and prevention)

[Validity of clinical records and information systems in studies of health-care delivery in primary care]. / Validez de la historia clínica y sistemas de información en los estudios de actividad asistencial en atención primaria.

OBJECTIVES: To examine how well the clinical process was recorded in the clinical history (CH), and care delivery on the activity sheet (AS). To assemble a series of recommendations on the validity of these documents for recording health care delivery. DESIGN: Multi-centred, observational, and cross-sectonal study. SETTING: Four medical clinics at 12 health centres in the Community of Valencia, Spain. PARTICIPANTS: There were 2051 attendances, with 284 CH and 407 AS involved. Main measurements and results. The information recorded by doctors in the CH and on the AS was validated by external observers who collected directly at the consultation the working day's entire care activity. The following was analysed: 1) in the CH, filling out of the "SOAP" form (basic info.); 2) on the AS, mean per professional per day of scheduled and on-demand patients, home visits and length of consultations; 3) information in the documents validated on the organisation of consultations; 4) analysis of care delivery according to how predictable it is and its clinical content; 5) clinical practice guidelines with validity and clinical usefulness indicators and reliability index (kappa). CONCLUSIONS: The documents validated do not properly reflect the reality of health care demand. There was an under-recording bias and validity problems that may limit their usefulness as sources of information for health care planning and management.